How Govt. Crack Downs on Drug Prescriptions Can Backfire Spectacularly and Kill Privacy
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The programs are supported by a mix of public and private funds. The Harold Rogers Prescription Drug Monitoring Program, administered by the Bureau of Justice Assistance, has awarded 146 grants to 47 states to support the planning, implementation and enhancement of PDMPs since 2003.
Some states’ programs issue reports only when they are requested by doctors, pharmacists or law enforcement, but most have the authority to issue unsolicited reports. However, not every program that has that authority is using it, says Green. The reports are most commonly sent to prescribers and pharmacists, she says, and secondarily to state regulatory officials and law enforcement. Typically, the program sends the prescriber a letter suggesting that they go to the PDMP to get the patient’s prescription history and see “what pills the patient is getting in their hands.”
There is no way the system can automatically distinguish between someone in legitimate pain and someone who’s scamming to get drugs, she explains, so it’s used “to alert a physician about “suspicious circumstances.”
“This is an information tool,” she says. “It can’t be used to make a final determination.”
Depending on their state’s law, the programs can also provide information to Medicare, Medicaid, state insurance programs, parents of a minor child, county coroners, mental health and drug abuse professionals, grand juries, and workers’ comp specialists.
The federal National All Schedules Prescription Electronic Reporting Program, established in 2005, requires an unsolicited report “when an individual has filled six or more controlled substance prescriptions of the same drug class, from six or more different prescribers, or six or more different pharmacies in a state, within a one-month period.” The federal government is also planning to use electronic health data to send warnings or drug histories of “patients at risk” to pharmacists and doctors.
Most states and the federal government allow law enforcement access to prescription databases if they have an active investigation. A smaller number require a warrant, subpoena, or probable cause. In Vermont, police and prosecutors can only receive information from a professional licensing board. In Pennsylvania, they have to ask the state attorney general for access, and Nebraska’s program is voluntary.
In Massachusetts, the Boston Globe reported in January, local police, prosecutors, and the DEA will have access to the state database if they have an open investigation. Ironically, that policy was instituted after budget cuts eliminated the state police unit investigating drug diversion.
West Virginia in January announced plans to upgrade its database, which has more than 30 million entries, and develop criteria to search for suspicious users and doctors. Access is currently limited to 15 state police officers and regional drug task forces; a state police official told legislators that “they have to have a reasonable suspicion to run someone’s name,” and that wide-open access would lead to legitimate patients and doctors being targeted, the Charleston Gazette reported.
Kentucky’s May 2012 law mandates that all prescribers must create a profile for each patient and check the database before writing or refilling a prescription. Law enforcement needs an “open investigation” but not a warrant to get information.
Reports from KASPER, the Kentucky All Schedule Prescription Electronic Reporting System, show all scheduled prescriptions for an individual over a specified time period, as well as the prescriber and the dispenser. The data is also available via the Web. The program states that it is designed to be “a source of information for practitioners and pharmacists” and “an investigative tool for law enforcement,” and is not intended to “prevent people from obtaining needed drugs” or “decrease the number of doses dispensed.”